Schoomaker spoke to health care professionals from around the world at the Army break-out session on the last day of a week-long Military Health System conference at National Harbor, Md.

The overall focus of the conference was to harness the power of 130,000 health care professionals and achieve the Quadruple Aim Performance Goals of medical readiness, experience of care, population health and per capita cost of care.

But the highlight on the final day was the Army Surgeon General's focus on his Top 10. These were:

-- Soldier Medical Readiness
-- Comprehensive Behavioral Health System of Care
-- Culture of Trust
-- Implementation of mTBI/Concussive Injury Protocols
-- Development of Medical Home Implementation
-- Pain Management Task Force/Comprehensive Pain Management
-- Implementation of the U.S. Medical Command/Office of the Surgeon General elements of Health Promotions and Risk Preventions
-- Base Realignment and Closure Completion and Transition
-- Physical Disability Evaluation System Legislative Initiatives for the Army chief of staff
-- Army Medicine's Role in Enterprise Transition.

Prior to listing the top 10, a multitude of teams and individuals from Army medical centers around the world were presented with awards, including Beneficiary Counseling and Assistance Coordinators, Debt Collection Assistance Officers, The Surgeon General's Annual Excalibur Awards, Military Treatment Facility Performance Awards and Access to Care Performance Awards.

While 10 initiatives were announced, a few garnered special attention by Schoomaker.

SOLDIER MEDICAL READINESS

Soldier Medical Readiness is spearheaded by Gen. Richard A. Stone, who assumed duties as the U.S. Army's deputy surgeon general for Mobilization, Readiness, and Reserve Affairs about two years ago.

The purpose of this program has been to ensure that all deploying Soldiers are medically and psychologically fit, and all returning Soldiers receive quality assessments to identify any medical or psychological conditions and provide evaluation and treatment services.

"There's a substantial effort on the part of the Army to really move the physical disability evaluation system, which is also on the Top 10, on to the next level, and that is to get us, as a MEDCOM, out of that process and really move us to a fitness-for-duty evaluation and pass on to the VA the physical disability adjudication," Stone said.

COMPREHENSIVE BEHAVIORAL HEALTH

In the years since the U.S. became engaged in the war on terror, behavioral health care providers across the Army have developed innovative ideas and programs, said Col. Rebecca Porter, chief of the Behavioral Health Division, Office of the Surgeon General.

In 2006, the Army established a readiness model, called Army Force Generation, which was designed to efficiently generate trained and ready forces for combatant commanders at sustainable levels, Porter said.

A year ago, MEDCOM established the Comprehensive Behavioral Health System of Care, or CBHSC, working group to standardize and coordinate care across the Army, she said. She added the the objective was to optimize care and maximize limited resources to ensure the highest quality care to Soldiers.

Currently, CBHSC is working to develop an integrated behavioral health information-technology system that will facilitate the use of standardized clinical data to optimize care, according to a chart Porter showed conference attendees. It also showed that her organization is working to identify best practices, fully integrate all Reserve and Guard components, and fully synchronize tele-behavioral health support.

TBI/CONCUSSIVE INJURY PROTOCOLS

Unlike a severe Traumatic Brain Injury, a concussion or mild TBI may not be readily identified, said Col. Barbara Springer, director of Rehabilitation & Reintegration Division in the Office of the Surgeon General.

Recognizing the importance of early detection, the Department of Defense and Department of Veterans Affairs have established system-wide screening and assessment procedures to identify concussion/mTBI in servicemembers and veterans, she said, at the soonest opportunity and through multiple points of care.

"The reason why this was put into place is because Soldiers will not take themselves out of the fight, just like athletes won't take themselves out of the game. So we had to put in policy to ensure that everybody is checked out," Springer said.
Currently in Afghanistan, there is a network of advanced concussion care resources, she said.

"For example, the Army stood up three level II concussion-care restoration centers in RC-East. And next month, the Army will stand up three more in RC-South," said Springer.

"And these restoration centers are really vital because they will keep Soldiers in the fight," Springer explained. "They can come in and get the care they need for their initial symptoms, because most concussions will get better within hours or a couple of days. If they do need more care, then they can go to Level III Concussion Care Programs and that's where advanced neuro-imaging and advanced special services are available."

"Also, there are neurologists, neuro-psychologists, occupational therapists and physical therapists who all work together to help keep our forces strong. These folks are also supported by TBI Tele-Health throughout the region," Springer continued.

The Soldiers will be educated, she said, so that they know what TBI is, understand the symptoms, and know they will get better.

"We will be remembered in this war for many things," Schoomaker said.

"(We've had) many improvements on the battlefield, not the least of which is trauma improvements, and medevac and infectious diseases, but (also for) our ability in the field in what's been called CPR for the brain so that a Soldier or warrior in combat will receive prompt care, evaluation and rehabilitation as close to the point of injury as possible.

"I think (this) will have a dramatic effect on reducing long-term consequences, both physical and psychological, on 21st century warfare," Schoomaker said.

COMPREHENSIVE PAIN MANAGEMENT

"Effective management of pain from the battlefield back, I think, is going to have implications that far go beyond the immediate relief of pain," Schoomaker said.

During the past nine years of conflict, and because Soldiers have been arriving back home in pain, the Army community, with partners in the Air Force and the Navy, began a number of initiatives, said Col. Chester Buckenmaier, Army Regional Anesthesia & Pain Management Initiative director.

"We have a pain infusion system out on the battlefield for the first time in history," Buckenmaier said. He added that Schoomaker realized that pain issues also had to be addressed at stateside facilities and even VA and civilian hospitals.

Pain continues to be the number-one reason people seek medical care in the United States.

"I chartered the Pain Management Task Force in August 2009 to provide recommendations for an Army Medical Command comprehensive pain-management strategy that is holistic, inter-disciplinary, and multi-modal in its approach; uses state of the art/science modalities and technologies; and provides optimal quality of life for Soldiers and other patients with acute and chronic pain," Schoomaker said in a recent article in U.S. Medicine, a monthly publication that serves health care professionals.

Since then, the Comprehensive Pain Management Campaign Plan was published in September and a pain workshop was held at the Special Operations Medical Association conference in December.

In the coming months, regional medical centers will continue to standardize interdisciplinary pain management centers, a pain education curriculum will be implemented, and establish an integrative medicine consultant, Buckenmaier said.

CULTURE OF TRUST

"Each of these programs reinforces our commitment to the needs of our patients and will be implemented based on the foundation of trust," Schoomaker said in the recent article for U.S. Medicine.

A culture of trust, said Schoomaker in the same article, is a shared set of attitudes, values, and practices that distinguish Army medicine's commitment to its beneficiaries to provide the highest quality and access to health services.

"It is based on confidence - confidence that we are competent, capable, and committed; that we will tell the truth and keep our promises.

"Trust, along with transparency, creates the conditions in which our internal talent thrives, our patients receive the best care, and our stakeholders trust that we, Army medicine, deliver what we say we will deliver," he said.

The Culture of Trust is being implemented this year and the phased roll out will consist of on-site training, skill building and other training initiatives, Schoomaker said.

"The culture of trust supports our vision of bringing value and inspiring trust. Trust is the foundation of Army medicine, and I have charged Maj. Gen. Patricia Horoho, deputy surgeon general, to champion a Center of Excellence to execute a unified strategy, standardizing processes and improving customer-service processes, focusing on outcome measures, and strengthening our culture of trust," Schoomaker said.

The Army break-out session came to a close with the photo of a Soldier.

"Look into the eyes of this Soldier," said Schoomaker.

"This is Sergeant Major Gallagher. He's the former command sergeant major for one of the battalions in the 3rd Infantry Division. He was made famous, you may recall, in a series of pictures in which he was taking cover behind a vehicle and returning fire, even as his medic dressed a wound in his leg.

"You can see the fatigue in his eyes, you can see the strain of multiple deployments. What you may not see is the psychological strain, the addiction to alcohol he had to overcome. Sergeant Major Gallagher is now the sergeant major of the Army Wounded Warrior Program.

"This is who we work for. And we have to be supportive of him and everything that is on his mind. Our job is to take rocks out of his rucksack meaning, to unburden him and her, in the case of a female Soldier, of what keeps them from being effective.

"(We must) relieve pain in a holistic way, that doesn't degrade performance and lead to addiction. If we do this, this Soldier is going to be much more powerful and resilient and will be protected. And that's your responsibility. You need to be out there, aggressively interacting with your communities to make that happen," Schoomaker said.